Radiation treatment is the use of high-energy x-ray beams to kill tumor cells. It is planned and administered by radiation oncologists. It used for malignant soft tissue tumors and metastatic bone tumors. Radiation is sometimes used for benign, aggressive soft tissue tumors. Many metastatic bone tumors are treated with radiation alone. The technology is continuously evolving and newer machines are able to target with more specificity the area of tissue to be treated, while sparing normal tissues from unnecessary radiation. The calculation of the type of radiation, the doses and angles of treatment is very technical and complex.
The main side effects are superficial, self-limited burning of the overlying skin and fibrosis (scarring) of the treated tissues. When the axilla (armpit) or groin is included in the treatment, long-term swelling of the arm or leg is often a side-effect. Rare complications can include bone fracture and even radiation-induced cancers.
Patient getting radiation treatment. After the initial planning phase, each treatment only takes a few minutes. Usually several weeks of brief, daily treatment are needed.
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Chemotherapy is the use of medication to kill tumor cells. The selection of medication depends on the type of tumor. The selection and administration of chemotherapy is performed by medical oncologists. Most chemotherapy is given intravenously.
Chemotherapy is often administered in a series of "cycles". Each cycle lasts two to three weeks and consists of one or more days of medication administration followed by two weeks or more of recuperation. Typically six or more cycles are administered.
The agents most commonly used for malignant bone and soft tissue tumors (doxorubicin, ifosfomide, cis-platinum) cause many side effects including hair loss, nausea and weight loss.
There is good evidence with malignant bone tumors (osteosarcoma, Ewing's Sarcoma) that chemotherapy significantly improves survival. The results efficacy of chemotherapy with malignant soft tissue tumors is less certain with some evidence that survival is improved.
While all tumors need a blood supply to grow, some types of tumors have a propensity to create a very dense and active blood supply. Giant cell tumors, metastatic renal cell (kidney) and thyroid cancers, in particular, have abundant blood supply. When these tumors are located in the spine or pelvis, the patient will often undergo "embolization" of the tumor before surgery. This significantly reduces the amount of blood loss at the time of surgery.
This procedure is performed by an interventional radiologist, i.e. a radiologist specially-trained in performing invasive radiologic procedures. A small catheter is inserted into a large nearby artery, usually in the groin, and threaded carefully toward the tumor under x-ray guidance. Once there, the radiologist fills the vessel with tiny plastic beads which cut off the blood supply to the tumor. The procedure can be done on an outpatient basis but, since it is typically done the day before surgery, the patient stays in the hospital overnight.
> An example of preoperative embolization for a large, metastatic renal cell (kidney) tumor in the pelvis: note how effectively the ample blood supply to the tumor is reduced.
Radiofrequency ablation is the use of heat to kill tumor cells. The technique is best suited for small soft tissue and bone tumors for which the goal is not necessarily complete eradication of the tumor. It is often used for small, painful metastatic bone tumors and for small- or intermediate-sized soft tissue tumors which are difficult or impossible to surgically remove.
The procedure is usually performed on an outpatient basis by an interventional radiologist.
The patient is placed in a CT scanner in order to precisely identify the location of the tumor.
A radiofrequency probe is then inserted into the tumor and electrical energy delivered to the tip. This causes the surrounding tissues to heat up. Once the desired temperature has been achieved, the current is turned off. If necessary, the probe is then repositioned to another part of the tumor and treatment continued.
It is an ideal treatment for osteoid osteoma which is a small, very painful benign bone tumor. These lesions have a typical appearance on X-ray and and usually respond very well to radiofrequency ablation.
> An example of osteoid osteoma of bone treated using a radio frequency ablation probe